Kino Hiromi, Ueda Koichi, Hirota Yuka, Okamoto Toyoko
Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2023 Mar 14;11(3):e4858. doi: 10.1097/GOX.0000000000004858. eCollection 2023 Mar.
Congenital facial anomalies with hypoplasia of the midface or lower face are associated with obstructive apnea syndrome. Although such patients underwent bone advancement surgery and their sleep apnea improved in the short term, it often recurred several years after surgery. It is difficult to perform another major osteotomy because of impairment of the facial contour or prior orthodontic treatment. Genioplasty was performed for genioglossus muscle advancement in patients with congenital anomalies and repeated sleep apnea. In this study, we evaluated the usefulness of this procedure and the mechanism for the improvement of sleep apnea.
Six patients were included: three with syndromic craniosynostosis, two with Treacher-Collins syndrome, and one with micrognathia by Goldenhar syndrome. Patients who had recurrence of sleep apnea after previous maxillomandibular osteotomies, or advancement and orthodontic treatment, received genioplasty for genioglossus muscle advancement. The patients were evaluated by body mass index, simple polysomnography, hyoid bone position on cephalogram, and the airway area on computed tomography images pre- and postoperatively.
Polysomnography showed a significant improvement in the apnea-hypopnea index. Cephalometric measurement showed significant results of the hyoid bone position from point B and the ramus plane. However, no significant results were obtained in the airway area assessment.
Genioplasty for genioglossus muscle advancement can improve apnea-hypopnea index by moving the hyoid bone forward. Genioplasty was useful in patients with congenital anomalies who had a recurrence of sleep apnea after several procedures.
伴有中面部或下面部发育不全的先天性面部畸形与阻塞性呼吸暂停综合征相关。尽管此类患者接受了骨前移手术，且睡眠呼吸暂停在短期内有所改善，但术后数年往往会复发。由于面部轮廓受损或先前接受过正畸治疗，很难再次进行大型截骨术。对于患有先天性畸形和反复睡眠呼吸暂停的患者，进行颏成形术以推进颏舌肌。在本研究中，我们评估了该手术的有效性以及改善睡眠呼吸暂停的机制。
纳入6例患者：3例患有综合征性颅缝早闭，2例患有特雷彻 - 柯林斯综合征，1例患有戈尔登哈综合征导致的小颌畸形。先前接受上颌下颌截骨术、前移术和正畸治疗后出现睡眠呼吸暂停复发的患者，接受颏成形术以推进颏舌肌。通过体重指数、简易多导睡眠图、头颅侧位片上的舌骨位置以及术前和术后计算机断层扫描图像上的气道面积对患者进行评估。
多导睡眠图显示呼吸暂停低通气指数有显著改善。头影测量显示舌骨相对于B点和下颌升支平面的位置有显著变化。然而，气道面积评估未获得显著结果。
推进颏舌肌的颏成形术可通过向前移动舌骨来改善呼吸暂停低通气指数。颏成形术对经过多次手术仍出现睡眠呼吸暂停复发的先天性畸形患者有用。
